Some of the team’s strongest criticism centered on how the jail fails to address the needs of inmates living with mental illnesses.

The team documented how a mentally ill inmate was left in the booking area for days. Correction staff said the man hadn’t been moved because there wasn’t room in a special housing area. They also said they didn’t want to move him because they likely would have to use force.

“The discovery of the mentally ill inmate in booking for multiple days needs immediate corrective actions. This should never occur,” the reviewers wrote.

The team recommended that inmates who may have mental health issues should be evaluated as quickly as possible by a mental health provider so treatment recommendations can be made early on. That could reduce the chances of having to resort to using force on sick inmates.

The team said it wasn’t clear whether staff who interacted with mentally ill offenders had received special training about how to recognize whether inmates are in crisis and the best ways to communicate with people affected by certain illnesses, including schizophrenia or bipolar disorder.

Most jails, the team wrote, require the police officers who arrest potential inmates to provide written information about any medical or mental health issues that surfaced during the arrest. Most jails also have a nurse assess the person being arrested before they are accepted into the jail, the team said.

Most jails also have clear policies that lead to predictable procedures for staff and inmates. Not at the county jail, however, where rules haven’t been updated for years and are poorly understood, the team found.

The lack of clarity shows up in nearly every aspect of the operation, the review found.

That includes how closely inmates are searched when being booked and how corrections staff maintain order while mingling at close quarters with inmates in living areas.

The team traced some of that problem to what it considers an incomplete transition in leadership when the sheriff’s office took over jail operations in 2009. Prior to that, it had been run for years as a department overseen by the county executive. During those years there was regular labor unrest, out-of-control overtime spending and scandals involving theft and improper contact between officers and inmates.

Now, much of the jail is unclean and the people who work there are inconsistent in how much of a mess they think is acceptable. The team wrote about seeing a empty bottle of some sort of a drink left next to an entrance door. It was “in the same place when we left the facility on the last day,” the report’s authors said.

“From booking to the housing units, the facility needs to be deep cleaned and a schedule established to maintain it,” the team recommended.

While inmates complain about the food and several were concerned about the adequacy of medical care, the team did not hear many complaints about corrections officers.

“They overwhelmingly felt the staff were doing their jobs and cared about their welfare,” the team found.

It was March when County Executive John Lovick, who was then sheriff, asked for the review.

Experts from Miami’s Dade County in Florida and Nashville, Tenn., visited the jail. The NIC team returned this week to complete its observations and make recommendations, particularly focused on the jail’s medical operations.

Shortly after being appointed sheriff in July, Trenary sought another perspective. He asked the Pierce County Sheriff’s Office to examine medical operations at the 1,200-bed jail in Everett. That county has been wrestling with similar jail challenges.

Based on recommendations from Pierce County, Trenary took immediate steps to improve medical care at the jail by hiring a doctor. Previously, medical care was limited at the jail to that provided by nurses.

“Our number one priority is to ensure the safety of our corrections staff and inmates,” Trenary said Monday. “The results and recommendations from all three reviews will provide us the opportunity to improve our jail operations and be better informed when looking to make changes to policy and procedure.”

The request by the sheriff’s office for federal help followed two high-profile deaths involving inmates who were both in their 20s.

Lyndsey Elizabeth Lason, 27, suffocated at the jail in 2011 when her infected lungs slowly filled with fluid. Other inmates said Lason had pleaded for medical care. A $10 million wrongful death claim is pending.

Michael Saffioti, 22, died at the jail in July 2012 from bronchial asthma triggered by severe allergies. His family has hired a Seattle attorney to press for answers. He was booked into the county jail as a courtesy because people were concerned that his health would be at greater risk in the city of Lynnwood’s jail. A judge there had ordered Saffioti locked up for misdemeanor marijuana possession.

The family of Bill Williams, 59, also has raised questions about his death in September 2012. Arrested for shoplifting, the mentally ill man collapsed and died after being shocked twice with an electronic stun gun.